lRENAL IMPAIRMENTManufacturer advises caution—no
information available.
lMONITORING REQUIREMENTSMonitor neutrophil count
weekly and discontinue treatment if neutropenia develops.
lPATIENT AND CARER ADVICE
Blood disordersPatients or their carers should be told how
to recognise signs of neutropenia and advised to seek
immediate medical attention if symptoms such as fever or
sore throat develop.lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: capsule, oral suspension, oral solution
Oral solution
CAUTIONARY AND ADVISORY LABELS 14
▶Ferriprox(Swedish Orphan Biovitrum Ltd)
Deferiprone 100 mg per 1 mlFerriprox 100 mg/ml oral solution
sugar-free| 500 mlP£ 152. 39 DT = £ 152. 39
Tablet
CAUTIONARY AND ADVISORY LABELS 14
▶Ferriprox(Swedish Orphan Biovitrum Ltd)
Deferiprone 500 mgFerriprox 500 mg tablets| 100 tabletP
£ 152. 39 DT = £ 152. 39
Deferiprone 1 gramFerriprox 1000 mg tablets| 50 tabletP
£ 175. 25 DT = £ 175. 25Desferrioxamine mesilate
(Deferoxamine Mesilate)
lINDICATIONS AND DOSE
Iron poisoning
▶BY CONTINUOUS INTRAVENOUS INFUSION
▶Neonate:Initially up to 15 mg/kg/hour, max. 80 mg/kg in
24 hours, dose to be reduced after 4 – 6 hours, in severe
cases, higher doses may be given on advice from the
National Poisons Information Service.▶Child:Initially up to 15 mg/kg/hour, max. 80 mg/kg in
24 hours, dose to be reduced after 4 – 6 hours, in severe
cases, higher doses may be given on advice from the
National Poisons Information Service
Aluminium overload in dialysis patients
▶BY INTRAVENOUS INFUSION
▶Child: 5 mg/kg once weekly
Chronic iron overload (low iron overload)
▶BY SUBCUTANEOUS INFUSION
▶Child:Initially up to 30 mg/kg 3 – 7 times a week, to be
given over 8 – 12 hours, the dose should reflect the
degree of iron overload
Chronic iron overload (established overload)
▶BY SUBCUTANEOUS INFUSION
▶Child: 20 – 50 mg/kg dailylUNLICENSED USE
▶When used for Iron poisoningLicensed for use in children
(age range not specified by manufacturer).
lCAUTIONSAluminium-related encephalopathy (may
exacerbate neurological dysfunction)
lINTERACTIONS→Appendix 1 : iron chelators
lSIDE-EFFECTS
▶Common or very commonArthralgia.bone disorder.fever.
growth retardation.headache.muscle complaints.nausea
.skin reactions
▶UncommonAbdominal pain.asthma.hearing impairment
.vomiting
▶Rare or very rareAngioedema.blood disorder.cataract.
diarrhoea.dizziness.encephalopathy.eye disorders.
hypersensitivity.hypotension (more common when given
too rapidly by intravenous injection).increased risk of
infection.nerve disorders.nervous system disorder.paraesthesia.respiratory disorders.shock.tachycardia.
thrombocytopenia.vision disorders
▶Frequency not knownAcute kidney injury.hypocalcaemia.
leucopenia.renal tubular disorder.seizure.urine red
lPREGNANCYTeratogenic inanimalstudies. Manufacturer
advises use only if potential benefit outweighs risk.
lBREAST FEEDINGManufacturer advises use only if
potential benefit outweighs risk—no information
available.
lRENAL IMPAIRMENTUse with caution.
lMONITORING REQUIREMENTS
▶Eye and ear examinations before treatment and at
3 -month intervals during treatment.
▶Monitor body-weight and height in children at 3 -month
intervals—risk of growth retardation with excessive doses.
lDIRECTIONS FOR ADMINISTRATIONFor full details and
warnings relating to administration, consult product
literature.
▶When used for Chronic iron overload or Aluminium overload in
dialysis patientsForintravenousorsubcutaneous infusion,
reconstitute powder with Water for Injection to a
concentration of 100 mg/mL; dilute with Glucose 5 %or
Sodium Chloride 0. 9 %. Inhaemodialysisorhaemo-filtration
administer over the last hour of dialysis (may be given via
the dialysisfistula).Intraperitoneal: may be added to
dialysisfluid. In CAPD give prior to the last exchange of
the day.
lPATIENT AND CARER ADVICE
Medicines for Children leaflet: Deferasirox for removing excess
ironwww.medicinesforchildren.org.uk/deferasirox-removing-
excess-iron- 0lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Powder for solution for injection
▶Desferrioxamine mesilate (Non-proprietary)
Desferrioxamine mesilate 500 mgDesferrioxamine 500 mg powder
for solution for injection vials| 10 vialP£ 39. 90 | 10 vialP
£ 50. 00 (Hospital only)
Desferrioxamine mesilate 2 gramDesferrioxamine 2 g powder for
solution for injection vials| 1 vialP£ 20. 00 (Hospital only)
▶Desferal(Novartis Pharmaceuticals UK Ltd)
Desferrioxamine mesilate 500 mgDesferal 500 mg powder for
solution for injection vials| 10 vialP£ 46. 633 Neutropenia and stem cell
mobilisation
3.1 Neutropenia
Neutropenia
Management
Recombinant human granulocyte-colony stimulating factor
(rhG-CSF) stimulates the production of neutrophils and may
reduce the duration of chemotherapy-induced neutropenia
and thereby reduce the incidence of associated sepsis; there
is as yet no evidence that it improves overall survival.
Filgrastim (unglycosylated rhG-CSF) p. 579 and lenograstim
(glycosylated rhG-CSF) p. 580 have similar effects; both have
been used in a variety of clinical settings, including
cytotoxic-induced neutropenia, and neutropenia following
bone marrow transplantation, but they do not have any
clear-cut routine indications. In congenital neutropenia
filgrastim usually increases the neutrophil count with an
appropriate clinical response. Prolonged use may be
associated with an increased risk of myeloid malignancy.578 Neutropenia and stem cell mobilisation BNFC 2018 – 2019
Blood and nutrition9